Hi all
My Dad’s GP has prescribed Alendronic Acid 70mg tablets without explaining why.
My Dad is now on Adcal -D3 1x daily, 9mg Prednisolone daily and 1x weekly Alendronic Acid.
Is it normal to be prescribed Alendronic Acid? Also, how far apart should this be taken from Pred?
Thanks
Lindsay
It is fairly standard practice - has he had a dexascan? Does he have any gastric or swallowing issues?
AA is prescribed to prevent the loss of bone density which many doctors are convinced is inevitable with pred. It doesn't always happen and if the bone density is good at the start then calcium and vit D may be enough on their own - but they are essential with AA.
It is only taken 1x a week and it must be taken, with tap water only, nothing else at all, on an empty stomach before any other medications. Then he must remain upright for 1/2 to 3/4 hour and then can carry on as normal.
Hi
No, he hasn’t had a Dexa scan. They GP just added it to his prescription without any explanation.
He doesn’t have any swallowing or gastric issues.
Would you still take the AA?
Thanks
I have never taken it, well, I took 4 tablets before stopping. My dexascan was fine and we agreed to wait and see what happened - and none of my dexscans since have shown a significant deterioration so I still don't take it - after nearly 14 years.
He is 72 so maybe his GP is being cautious. It’s a shame he wasn’t offered a scan. Does he have to wait an hour after the AA to take his Pred.
At least 30 minutes accroding to the NHS,
I just googled "time after alendronic acid to take medication" and it brings up a a whole load of NHS Trust handouts but they are all as PDFs so I can't just post a link. They explain the whys and wherefores of AA and I'm sure you would find them helpful,
Before he starts taking the, do try and get a thorough dental examination just in case anything invasive needs to be done like extractions. Many dentists get very iffy about patients on AA. And good dental hygiene is essential while on it.
hi Lindsayf. My pmr was diagnosed when 72 (2017) Pred, Alendronic and 2 x EvacalD3 prescribed. No Dexascan. All ok, even had tooth extraction no problem. Asked for /had Dexascan December 2022, result ‘satisfactory’ (?) doc took me off AA, I also try to include as much vitD in my diet. Next Dexascan due in 3 years, normal procedure I think.
It needs to be a large glass of water - see instructions with tablets
thank you
His doctor should order a scan. Why take medicine when you do not know if you need it? It is serious medicine.
my lovely mum is on it and has been since going blind due to GCA 3.5 years ago-She calls it her’ standy up tablet’ takes it as soon as she gets up once a week before breakfast and other meds x
My late hubby used to call it that as well…
how is your mum? … give her my best wishes please.
Has you dad had a Dexa scan to show he actually needs AA? or does he already now if he is has osteoporosis? If not, the suggest one is requested...
AA taken first thing as PMRpro has advised...then other meds and breakfast. This link explains about timings with Adcal-D3. can I ask why your dad taking it once a day - and what dose? It usually comes as 2 doses ..
healthunlocked.com/pmrgcauk...
Hi
No, he hasn’t had a Dexa scan or been offered one. He has never been told he has Osteoporosis.
So even without a scan or being told he has Osteoporosis, it is still advisable to take 1 AA weekly?
They have also dropped his Ad-Cal from 2 x daily to 1 x daily.
Thanks
Personal opinion really -I took it for 4 years with no issue - but as I’d had an hysterectomy aged 37 and family history thought it sensible. But if he doesn’t really need it then Adcal should suffice -and suggest he takes vitamin K2 mk7 to get calcium to bones. So if doctors have changed Adcal -what daily dose is he on?
AA -usually says take with plenty of water - don’t lie down -sitting is fine for 30mins before any food/drink/meds, I used to shower or read emails.
sorry for the delay. I’ve checked and he is on 1500 AD-Cal. He was also supplementing with VIT D and his bloods came back that his VIT D was very high. He has stopped taking the VIT D and only taking AD-Cal now. I need to find a K2 as I’d not think AD-Cal has that in it.
Have they thought to investigate why his vit D level is high? You usually have to take a phenomenally high daily dose of a supplement for a very long time to get a very high blood level - how much had he been taking?
I’ve asked him to get his blood results from him GP so I can look at the levels. He was taking about 9 drops of Nature Provides 3000iu for 3 months as his levels were low. He continued taking that and the ad-cal so I wonder if that it was has push him as high
It may have but it shouldn't have. AdCal only has 800IU per day in the recommended dose, However, the dose is 20 mcg per drop, that is 8000 IU per day if he was taking 9 drops which is quite a lot. Recommended dose is 2 drops.
Is it really high - or does the GP think it is high as he is sticking to the old recommended level? And had the GP provided the dose to replenish his vit D level and also checked his vit D he'd have had more control wouldn't he!
I know his levels were low before going into VIT D as we got his bloods done privately. His GP draws his bloods every month so hopefully with just being on Ad-cal it will be in the maintenance dose now. His GP is like a chocolate fire guard. It stresses me out trying to help him at times as I don’t trust his GP.
Adcal is a combination of Calcium and Vit D - so if a he was taking extra Vitamin D on top of that no wonder his levels were high .. and no it doesn’t contain Vit K2 - so you need to buy that… and you want Vitamin K2 Mk7. Readily available.
yes, he is only taking Ad-cal now. Do you know any good brands for VIT K2 please?
I get mine from ZipVit (online) -but just have a look online and to be honest, all much of a muchness…
thank you. I’ve just ordered it as it’s 1 a day so he will be happy with that.
If your father’s GP is like mine he has a tick of list. Long term steroids = prescribe alendronic acid! I haveca continual fight with my GP. I had a Dexascan recently and I am “Iron Woman”.
I really think he should ask why his Adcal has been reduced and if he can have a bone density scan before starting the AA. I took it for 3 weeks and it gave me heartburn which is not something I usually have. My doctor rang and told me to stop taking it until I had been to my dentist and I took that time to look into it. I never took any more and my bone density scan was normal
I’ll speak to him tomorrow and get him to ask the GP for a scan. When I picked up his prescription, I did ask why the Ad-Cal was only once a day and she didn’t know. I will also get him to mention that. Than you 
Actually the most important thing is the amount of Adcal daily- can you confirm the dose he is on. Doesn’t really matter if it’s once or twice a day - but the overall amount.
Except if the calcium dose is more than about 600mg the body doesn't absorb it all. It will if it is 2x a smaller dose but not 1x a higher dose.
My Rheumy wanted me to take AA but having read all the comments about it here I refused and requested a scan. The scan was good for my age but he still wanted me to take it. I refused, left the Rheumy and looked after myself with all the help and advice on here. 3 years later my second Dexa scan was still good for my age.
Unfortunately AA is on their tick list to prescribe with long term Pred.
I had a flare in February of this year so my pred dose went up and my rheumy also put me back onto AA. I also had my Dexa scan which was due anyway, it was fine but they advised that if my dose of Pred was above 7mg, as a precaution, I should take AA. As for the calcium supplement, they calculated how much, on average, I consumed in a week as to whether it would be necessary for me to take it.
He is going to ask for a scan and then take it if he needs it. I don’t rate his GP but that is because I had a terrible time under his supposed care so I’m cautious of him.
I was prescribed it by the hospital at the same time as pred. I did all the research and didn't like the sound of it. I requested a dexa scan and have had 2 so far on NHS, no problem. All good and no osteoporosis. I take 2 AdCal-Vit D3 and K2 daily. I was 72 when diagnosed but all the men I know have been off pred within 2 years. So that's encouraging.
Hello LIndsayf. I am slightly different insofar as I am intolerant of Dairy produce and so I am delighted to take my AA every Sunday morning, and have given me no side effects other than looking after my bones My last Dexa scan showed I was teetering on the edge of Osterporosis so am happy with that. I have tried all the pseudo milks but just do not like them at all so would rather go without, .I am now 82 so still trundling along , best wishes
Hello Lindsay,
First of all the doctor should not have prescribed alendronic acid, without saying why. Secondly it can have some unpleasant side effects which disagree with some people. These effects are worth exploring before any further use as several people I know have had problems after taking alendronic acid. Your father has the right to question any medicine that he has been prescribed, before taking it. Unhappily too many older people are too much in awe of the doctor, who, though knowledgeable, is not God. I believe also that doctors have received certain incentives for prescribing alendronic acid and are more inclined to offer it for this reason.
It may be that it will help your father, which would be a good thing, but it would be just as well to be aware of the side effects, so as to alert the doctor if these occur.
Please look up Alendronic Acid on the NHS site for information.
I have had very bad experiences with this GP so I always worry when my Dad goes to see him. He won’t change surgery so I try as best as I can to check his medication. He did not explain why he needed it just added it to his monthly prescription. My Dad has now told me that he will not be taking AA unless he gets a scan and it shows he needs it.
Thank you
"doctors have received certain incentives for prescribing alendronic acid"
Illegal in the UK ... Don't even get pens these days!
This is a bit lengthy, it doesn’t say that the doctors profit directly from the points given, but the benefit goes to other medical care.
PRESCRIBING INCENTIVE SCHEME 2008-09 (SHORT VERSION)Target Incentive Scheme CriteriaIncentive Payment For Achievement1. StatinsSimvastatin and Pravastatinshould comprise a minimum of 75% of all statin prescribingHigher award for achieving 80% For Achieving 75% =1pt For Achieving 80% =2pts2. Proton Pump Inhibitors 85% of Proton Pump Inhibitors to be prescribed as omeprazole or lansoprazole capsules.Higher reward for achieving 90% For achieving 85% = 1pt For achieving 90% = 2 pts 3. Renin-Angiotensin antagonists ARBs to be no more than 25%of all renin-angiotensin antagonist prescribing.Higher award for 20% or lessFor achieving 25% = 1pt For achieving 20% = 3ts 4. Antibacterials Cephalosporins and Quinolones to comprise no more than 10% of all antiobitoic prescribingHigher award for 7% or less For achieving 10% =1pt For achieving 7% = 2pts5. Bisphosphonates 80% of all bisphophonate and strontium ranelate prescribing to be for Alendronic Acid 70mg once weekly For achieving 70% = 1pt For achieving 80%=2pts6. SSRIs 80% of all SSRIs as fluoxetine, citalopram or sertraline.Higher reward for 85% For achieving 80% = 1pt For achieving 85% = 2pt 7. Anti-platelets(clopidogrel & low-dose aspirin) Clopidogrel will comprise no more than 10% of prescribing in this area.Higher award for 8% or lessFor Achieving 10% = 1pt For achieving 8% =2pts8. Blood Glucose Test Strips Average number of blood glucose testing strips per diabetic patient should be no more than 100 per 6-months For Achieving 100-125 = 1pt For achieving <100 = 2pts 9. GlitazonesCompletion of PCT Audit of Glitazone Prescribing in Heart Failure and CVDand submission of Action PlanCompletion of audit AND submission ofAction Plan = 2pts10. Enteral Nutrition100% of patients(care home AND community) should have documented evidence on their notes of assessment and monitoring 100% of care home patients’ sip feeds to be acute, not on repeat, and scripts to be issued only on receipt of Request Form as per Procedure for Ordering Sip Feeds For achieving the establishment of a Register of all sip feed patients = 1pt For Achieving 80% documentation of assessment and monitoring of all patients = 1pt 11. Specials 100% of requests for ‘specials’ and unlicensed medicines to be notified to PCT using ‘Unlicensed specials authorisation’ formFor achieving 90% = 1pt For Achieving 100% = 2pts12. Red List Compliance with the PCT “Red List” of drugs not to be prescribed For achieving 5-2.5 items per ASTRO PU = 1pt For Achieving < 2.5 items per ASTRO PU = 2pts Calculation of Payment:• Each point will be worth £125 plus weighting as per QOF.• The maximum number of points available is 25• Disease prevalence is not considered.• The total number of points achieved will be calculated by measuring the practice’s performance for each indicator.• Achievement will be measured from 1st June 2008 to 31st March 2009.• Achievement will be calculated from ePACT data.• If there is a significant difference between ePACT data and what a practice considers it has achieved for any indicator, data from the clinical system of the practice will be used for verification. Choice of Indicators:• The Indicators reflect both East of England Strategic Health Authority Key Performance Indicators and PCT prescribing policies.• There are clinically driven indicators e.g. Glitazone Audit, as well as cost-efficiency indicators.• The indicators have been chosen after discussion with the Locality GP prescribing leads and other interested parties. Use of Payment from Scheme • Payments received from this Scheme may only be used to benefit patient care.
(Interesting information regarding statins ). Date is 2008-2009, but I doubt that things have changed.
Your thoughts on this.
What I was talking about was pharmaceutical companies making payments or gifts to make their name/drug more likely to be used.
The Prescribing Incentive Schemes aren't rewards for prescribing a particular drug, They are the "targets" that GP practices are to fulfil to improve efficiency and patient care:
"Historically there has been an incentive scheme in place for member practices since the PCT formed in 2002. The 2020/21 Prescribing Incentive Scheme (PIS) builds on previous years schemes and aligns with the Bedfordshire CCG, Quality, Innovation, Productivity and Prevention (QIPP) agenda.
The purpose of the scheme is:
To encourage and reward medicines optimisation, cost-effective and high quality prescribing.
Principles
• Incentives should reward improvements in patient care and efficient use of resources. It is therefore important that the PIS does not simply reward low cost prescribing, but should include criteria relating to the quality of prescribing.
• The scheme is designed to support financial stability without compromising patient care.
• The scheme should encourage practices to consider how patients can be supported to get the best from their medicines, and how they can benefit from cost-effective quality prescribing.
• The CCG recognises that practices that are already achieving the targets specified in the scheme should be rewarded in the same way as those practices meeting the targets for the first time.
• Practices may want help or support to facilitate change. The Medicines Management Team (MMT) is able to provide advice and support to practices to implement the scheme.
• The scheme will run from 1st April 2020 to 31st March 2021."
They are renewed at intervals. Whether they improve care is a moot point!
I agree, but surely they are more likely to push certain drugs if they have these targets to achieve. I agree about the drug companies by the way.
It is less certain drugs as managing certain conditions I think. And the underlying concept that there is a pill for every ill.
Thank you for replying. Sorry not to have got in touch with you earlier, but my husband has been discharged from rehabilitation for an ankle fusion and a bone graft so it’s distracted me somewhat. As always your information is very useful.
I thought it was standard practice with GPs. As soon as they perscribe Predisolone they also give you Alendronic acid and Evacal. I have been taking it for 4 years without any issues. Never had a Dexa scan. I was going to ask about coming off it on low doses of Pred but never got around to it.
Alendronic acid and other bisphosphonate drugs are not to be taken for ever. I believe it used to be said to take a 'holiday' from them after 3 years, but that may be 5 years now. They stay in our bones for many years after stopping them. Do ask for a Dexa scan to see the state of your bones.
I do have osteoporosis and was on Risedronate (similar to AA) for 5 years, but now off it. I'm due for another Dexa scan next week to see how my bones are after being off the drug for over a year.
I have been prescribed AA by my rheumatologist. My dexacan was ok. The weekly and the daily dose (same precautions). I do have acid reflux, esophageal spasms and difficulty swallowing. Took AA a couple of times. It upset my digestive tract badly. I take it no longer. I do take 3000 IU of D3 and K2, and a calcium supplement in the form of Tums (which has 1000 mg. of calcium with it.
Trying to figure out when to take the AA was also a pain, because I'm an early riser. Coffee and some meds first thing at 6:15 AM. That would mean I would have had to rise about an hour earlier, take the AA on a completely empty stomach with water and then sit or stand for AT LEAST 1/2 hour before taking anything else. Rheumy is a great perponent of AA, who did a paper on it I do believe. Was I just a guinea pig? Dexacan would have to be pretty bad for me to even try to take it again.
She never asked Pro. I thought the fact that I'm taking rabeprazole (2x per day) might have been a clue. She was adamant I take it; I was not.
My GP did the same. I went to pick up other usual meds and was handed AA as well It was awful. I gave GCA rather than PMR but my Rheumy nurse was horrified.
And took me straight off it. I was then sent for a Dexascan which was perfectly OK, I have never fractured or broken a bone etc.
It isn't the easiest tablet to take nor does it do your gastric system any good.
Well done for being your dad's advocate
My doc mentioned it just after diagnosis, fortunately I had found this forum by then and I asked if I could have a DEXA scan first and then we could discuss the results. Results came back excellent and it's not been mentioned since. My last DEXA scan ( January, ) was also excellent.
don’t take any of these medicines they are toxic for you my mum started taking Alendronic Acid and it caused her to get excruciating pain all over her body and she couldn’t move for weeks she was in agony and so the doctor put her on steroids and she was on them for two years until I did some research and found out that it was the Alendronic acid that caused her to get the pain she is now off both medicines and she is so much better. All these drugs do is cause more problems big pharma are evil
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